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Unnecessary Antimicrobial Use in Patients with Current or Recent Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Megan K. Shaughnessy ,
William H. Amundson ,
Michael A. Kuskowski ,
Douglas D. DeCarolis ,
James R. Johnson  and
Dimitri M. Drekonja
Megan K. Shaughnessy*
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota
William H. Amundson
Affiliation:
University of Minnesota Medical School, Minneapolis, Minnesota
Michael A. Kuskowski
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
Douglas D. DeCarolis
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
James R. Johnson
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota
Dimitri M. Drekonja
Affiliation:
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis, Minnesota
*
250 (Mayo Building) Suite D-416, 420 Delaware Street SE, Minneapolis, MN 55455 ([email protected])
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Abstract

Objective.

To determine the fraction of unnecessary antimicrobial use among patients with current and/or recent Clostridium difficile infection (CDI).

Design.

Retrospective review from January 2004 through December 2006.

Setting.

Minneapolis Veterans Affairs Medical Center (MVAMC).

Participants.

Patients with new-onset CDI diagnosed at the MVAMC without another CDI diagnosis in the prior 30 days.

Methods.

Pharmacy and medical records were reviewed to identify incident CDI cases, non-CDI antimicrobial use during and up to 30 days after completion of CDI treatment, and patient characteristics. Two infectious disease physicians independently assessed non-CDI antimicrobial use, which was classified as unnecessary if not fully indicated. Factors associated with only unnecessary use were identified through univariable and multivariable analysis.

Results.

Of 246 patients with new-onset CDI, 141 (57%) received non-CDI antimicrobials during and/or after their CDI treatment, totaling 2,147 antimicrobial days and 445 antimicrobial courses. The two reviewers agreed regarding the necessity of antimicrobials in more than 99% of antimicrobial courses (85% initially, 14% after discussion). Seventy-seven percent of patients received at least 1 unnecessary antimicrobial dose, 26% of patients received only unnecessary antimicrobials, and 45% of total non-CDI antimicrobial days included unnecessary antimicrobials. The leading indications for unnecessary antimicrobial use were putative urinary tract infection and pneumonia. Drug classes frequently used unnecessarily were fluoroquinolones and β-lactams.

Conclusions.

Twenty-six percent of patients with recent CDI received only unnecessary (and therefore potentially avoidable) antimicrobials. Heightened awareness and caution are needed when antimicrobial therapy is contemplated for patients with recent CDI.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 2 , February 2013 , pp. 109 - 116
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013 

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References

1. McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . N Engl J Med 2005;353:2433–2441.Google Scholar
2. Owens, RC, Donskey, CJ, Gaynes, RP, Loo, VG, Muto, CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46(suppl 1):S19–S31.Google Scholar
3. Yee, J, Dixon, CM, McLean, AP, Meakins, JL. Clostridium difficile disease in a department of surgery: the significance of prophylactic antibiotics. Arch Surg 1991;126:241–246.Google Scholar
4. Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonald, LC, Fraser, VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45:1543–1549.Google Scholar
5. Dial, S, Alrasadi, K, Manoukian, C, Huang, A, Menzies, D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004;17:33–38.Google Scholar
6. Bliss, CZ, Johnson, S, Savik, K, Clabots, CR, Willard, K, Gerding, DN. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 1998;129:1012–1019.Google Scholar
7. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403–410.Google Scholar
8. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
9. Gonzales, R, Camargo, CA Jr, MacKenzie, T, et al. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med 2006;13:288–294.Google Scholar
10. Vanderweil, SG, Tsai, CL, Pelletier, AJ, et al. Inappropriate use of antibiotics for acute asthma in United States emergency departments. Acad Emerg Med 2008;15:736–743.Google Scholar
11. Mclsaac, WJ, Low, DE, Biringer, A, Pimlott, N, Evans, M, Glazier, R. The impact of empirical management of acute cystitis on unnecessary antibiotic use. Arch Intern Med 2002;162:600–605.Google Scholar
12. Cope, M, Cevallos, ME, Cadle, RM, Darouiche, RO, Musher, DM, Trautner, BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 2009;48:1182–1188.Google Scholar
13. Dalen, DM, Zvonar, RK, Jessamine, PG. An evaluation of the management of asymptomatic catheter-associated bacteriuria and candiduria at the Ottawa Hospital. Can J Infect Dis Med Microbiol 2005;16:166–170.Google Scholar
14. Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients. Arch Intern Med 2003;163:972–978.Google Scholar
15. Drekonja, DM, Amundson, WH, DeCarolis, DD, Kuskowski, MA, Lederle, FA, Johnson, JR. Antimicrobial use and risk for recurrent Clostridium difficile infection. Am J Med 2011;124(11):1081.e1–1081.e7.Google Scholar
16. Mullane, KM, Miller, MA, Weiss, K, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clin Infect Dis 2011;53:440–447.Google Scholar
17. Khatib, R, Riederer, KM, Ramanathan, J, Baran, J Jr. Faecal fungal flora in healthy volunteers and inpatients. Mycoses 2001;44(5): 151–156.Google Scholar
18. Nguyen, AJ, Nelson, DB, Thurn, JR. Pseudomembranous colitis after itraconazole therapy. Am J Gastroenterol 1999;94(7):1971–1973.Google Scholar
19. Kwon, JC, Kang, MK, Kim, SH, et al. A case of pseudomembranous colitis after voriconazole therapy. Yonsei Med J 2011; 52(5):863–865.Google Scholar
20. Horn, SD, Sharkey, PD, Bertram, OA. Measuring severity of illness: homogenous case mix groups. Med Care 1983;21:14–30.Google Scholar
21. Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis 1994;18:422–427.Google Scholar
22. Nicolle, LE, Bradley, S, Colgan, R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643–654.Google Scholar
23. Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50:625–663.Google Scholar
24. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.Google Scholar
25. Potjanapan, P, Dosa, D, Thomas, KS. Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Arch Intern Med 2011;171:438–443.Google Scholar
26. Polgreen, PM, Chen, YY, Cavanaugh, JE, et al. An outbreak of severe Clostridium difficile-associated disease possibly related to inappropriate antimicrobial therapy for community-acquired pneumonia. Infect Control Hosp Epidemiol 2007;28:212–214.Google Scholar
27. Hosoglu, S, Sunbul, M, Eroi, S, et al. A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol 2003;24:758–761.Google Scholar
28. Pepin, J, Saheb, N, Coulombe, MA, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.Google Scholar
29. Loo, VG, Poirier, L, Miller, MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar